Virtual Consultation | Dr. Wolfeld

Our office offers complimentary online hair loss consultations for those who live outside of the New York City area or are unable to make it to our Park Avenue office. These online consultations are confidential. Please fill out the form below with as much information as possible.

If you are local to the NYC area, please contact us to schedule your in-person consultation. This will allow the doctor to better evaluate your hair loss in our office.

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1. Your Information

First Name* This field is required.

Last Name* This field is required.

Phone* This field is required.

Email* This field is required.

Date of Birth* This field is required.

What is your occupation?* This field is required.

Street Address* This field is required.

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City* This field is required.

State* This field is required.

Zip* This field is required.

Country* This field is required.

2. Hair/Health Profile

What age did you first notice hair loss?

What have you done to learn about hair loss?

How did you hear about us?

What was it that convinced you to consider us for your hair transplant?

Are you currently taking Propecia?

For how long?

Have you ever taken Propecia? If so, why did you stop?

Are you currently taking Rogaine?

For how long?

Have you ever taken Rogaine? If so, why did you stop?

Do you take any other medications?

Please list medications and reason for taking

Do you have any pre-existing medical conditions?

Please provide details

Do you smoke?

How much?

Have you had a previous hair transplant?

Please list the clinic, physician, year, procedure type and details of your previous hair transplant.

3. Your Hair Transplant

Select the zones on your scalp you want to have treated.

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Front

Top

Small Crown

Expanded Crown

Have you consulted with another hair transplant doctor?

What treatment was recommended?

When are you thinking of scheduling your hair restoration procedure?

What are you most interested in learning more about?

Robotic Follicular Unit Excision (R-FUE)

Follicular Unit Transplantation (Strip Procedure)

Platelet Rich Plasma

Medical Treatment

All of the Above

Other

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Top Photo Upload

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Left Upload

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Right Upload

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Back Upload

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By completing this form, you are giving us permission to follow-up by phone, email or text.

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